MEDICARE: HOME LIVING SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	1847LS	ID

General Provider Information

NPI Number	:	1346236650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME LIVING SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 4869
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83205-4869
Country	:	US
Telephone Number	:	208-376-6810
Fax Number	:	208-376-6899

Provider Business Practice Location Address
First Line	:	106 S COLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-0932
Country	:	US
Telephone Number	:	208-376-6810
Fax Number	:	208-376-6899

Authorized Official
Title or Position	:	OWNER
Name	:	MR. TORI DANIEL SHAVER
Credential	:
Telephone Number	:	208-232-9392

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	11/14/2007

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Directions to “HOME LIVING SERVICES, INC ” Practice Location

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